Dr Logan Robert Gorges, MD | |
800 Riverside Dr, Waupaca, WI 54981-1943 | |
(715) 258-1000 | |
(715) 258-1042 |
Full Name | Dr Logan Robert Gorges |
---|---|
Gender | Male |
Speciality | Emergency Medicine |
Location | 800 Riverside Dr, Waupaca, Wisconsin |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1295146223 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207P00000X | Emergency Medicine | 0101260237 (Virginia) | Secondary |
207P00000X | Emergency Medicine | 74348 (Wisconsin) | Primary |
Entity Name | Thedacare Medical Center - Waupaca, Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1780782680 PECOS PAC ID: 3072504216 Enrollment ID: O20040524000645 |
Mailing Address | Practice Location Address |
---|---|
Dr Logan Robert Gorges, MD 3 Neenah Ctr, Neenah, WI 54956-3070 Ph: (920) 454-4229 | Dr Logan Robert Gorges, MD 800 Riverside Dr, Waupaca, WI 54981-1943 Ph: (715) 258-1000 |
Dr. Amy T Kenworthy, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 800 Riverside Dr, Waupaca, WI 54981 Phone: 715-258-1000 | |
Francesca L Detrana, DO Emergency Medicine Medicare: Medicare Enrolled Practice Location: 800 Riverside Dr, Waupaca, WI 54981 Phone: 715-258-1000 Fax: 715-258-1632 | |
Dr. Matthew Paul Nelson, D.O. Emergency Medicine Medicare: Medicare Enrolled Practice Location: 800 Riverside Dr, Waupaca, WI 54981 Phone: 715-258-1000 | |
Dr. Charles Conger, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 800 Riverside Dr, Waupaca, WI 54981 Phone: 715-258-1041 | |
Dale T Bertram, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 611 Honey Bear Ct, Waupaca, WI 54981 Phone: 608-516-9278 | |
Matheen Ahmad Mohabbat, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 800 Riverside Dr, Waupaca, WI 54981 Phone: 715-258-1000 |